Case Studies In Multiple Sclerosis

This handbook is a collection of clinical narratives that underscore the heterogeneous and unpredictable presentation of multiple sclerosis (MS) and give real-world clinical context to recent drug developments. This accessible and concise publication is intended to be used by a wide range of medical professionals, from specialist neurologists to medical trainees with an interest in neurology. An ideal clinical resource, Case Studies in Multiple Sclerosis provides an evidence-based discussion of each case, with an aim to enhance effective diagnosis and treatment of patients with MS and MS-related conditions.

The use of case studies is vital as an educational technique in medicine, particularly to clinicians, because it illustrates current medical methodology and values. This issue includes case studies in all the major subspecialties within neurology such as headache, multiple sclerosis, sleep, dementia, movement disorders, neck and low back pain, epilepsy, cerebrovascular disease, neuro-ophthalmology, syncope, and critical care.

This case study is about a 29-year-old professional oboe player who was first diagnosed for optic neuritis and then for multiple sclerosis (MS). MS is an example of a T-cell mediated autoimmune disease, wherein there is an autoimmune attack on the integrity of the central nervous system.

Multiple Sclerosis: The History of a Disease won a 2005 ForeWord Book of the Year Silver Medal! The basic facts about multiple sclerosis are well known: it is the most common neurologic disease of young adults, usually beginning with episodic attacks of neurologic symptoms, then entering a progressive phase some years later. Its onset has an average age of 30, and occurs in about 1 in 500 individuals of European ancestry living primarily in temperate climates. There appears to be a complex interaction between a genetic predisposition and an environmental trigger that initiates the disease. But these facts do not convey the impact of the disease on the people whose lives it affects. In this elegantly written and comprehensive history, we meet individuals who suffered with MS in the centuries before the disease had a name, including blessed Lidwina of Holland, who took joy from her misery, believing that she was sent to accept suffering for the sins of others; Augustus d'Est, grandson of George III and cousin of Queen Victoria, whose case shows how someone with access to the best of medical care of the age was understood and managed; and Heinrich Heine, the great German poet, who also had access to all medical services that were available, but who progressed into his mattress grave in two decades, aware of the loss of physical ability while still able to compose great poetry to the end. From these early cases the author demonstrates how progress in diagnosing and managing multiple sclerosis has paralleled the development of medical science, from the early developments in modern studies of anatomy and pathology, to the framing of the disease in the nineteenth century, and eventually to modern diagnosis and treatment. From beginning to end, Dr. Murray takes us on a fascinating journey of discovery, in the process showing how the evolution of our understanding of multiple sclerosis has been part of the greater history of medical knowledge.

This issue of the Neurologic Clinics is being edited by the series Consulting Editor, Dr. Randolph Evans, and will be a special issue focusing on patient case studies of a board range of neurological diseases and disorders. Topics and cases covered include, but are not limited to: cerebrovascular disease, multiple sclerosis, syncope, epilepsy, tremor, dementia, neurologic issues in pregnancy, and medicolegal cases.

Case Studies in Systemic Sclerosis deals specifically with Systemic Sclerosis in a case study format. Each case presentation includes illustrative figures, a discussion of the pathophysiology relevant to the case, a discussion of management that is both evidence-based and expert opinion-based and several key references for further reading. With its easy-to-use format, this book presents multiple different manifestations of Systemic Sclerosis to a wide range of readers. Because this disease has a broad range of systemic features, Case Studies in Systemic Sclerosis is a valuable reference tool not only to the community of rheumatologists (trainees, academic and private practice rheumatologists) and dermatologists, but also potentially to internists, gastroenterologists, pulmonologists, cardiologists and nephrologists.

The value of prospective long-term studies on the features and course of multiple sclerosis is determined by the reliability with which relevant infor mation is documented. This involves two basic problems: I) The docu mentation system used must be detailed enough to provide adequate data on the essential features and course of the disease in a given case; on the other hand, it must not be so complicated and cumbersome as to preclude its use in the routine care of MS patients. 2) Since no system can fully anticipate new problems and scientific approaches that may become impor tant at some future time, the system must be open to provide the possi bility of adding and correlating the data of special research studies with the . basic data. These considerations led to the development of the basic documentation system described here and employed for the analysis of clinical data in this monograph. The work was carried out with the help of the Deutsche Forschungsgemeinscha/t as a part of its research program on multiple sclerosis and related demyelinating disease. A basic documentation pool including the data of more than 2 000 patients has been accumulated in the last six years. The system has been put to practical use in a number of epidemiologic surveys completed or under way, in following up the cases in an epidemiologic observation area in South Lower Saxony, and in studies on spasticity, cerebrospinal fluid findings, clinical forms and neuro physiological aspects of MS.